POS0454 WHAT ROLE DO SOCIOECONOMIC FACTORS PLAY IN PATIENTS WITH PERSISTENT ACTIVE RHEUMATOID ARTHRITIS? DATA FROM A LARGE UK EARLY INFLAMMATORY ARTHRITIS AUDIT
Authors: M. Adas, S. Norton, A. Cope, M. H. Buch, J. Galloway, E. Nikiphorou
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The basis for progression to a refractory disease state in up to 20% of patients with rheumatoid arthritis (RA) is unclear. Recent evidence suggests that non-biological characteristics, such as psychosocial factors, may interplay with biological (disease-related) factors to drive refractory disease in inflammatory arthritis<sup>[1]</sup>. <h3>Objectives</h3> To explore which biological and non-biological factors associate with persistent active RA (pactiveRA) in the first year, despite use of conventional synthetic DMARDs. <h3>Methods</h3> Observational cohort data from adult early RA patients in the National Early Inflammatory Arthritis Audit (NEIAA) across England and Wales between May 2018 and Oct 2022, were acquired. Patients were defined as having pactiveRA based on three consecutive Disease Activity Scores (DAS28) of &gt;3.2 at baseline, three and 12 months of follow up. Controlled RA (contRA) was defined as patients with a DAS28 ≤ 3.2 at the three and 12 month time-points, (having started off with a baseline DAS28 of &gt;3.2). Univariable, followed by multivariable analyses were applied, the latter using stepwise forward logistic regression to explore associations with pactiveRA. PactiveRA status was used as the outcome variable. Age and gender were included in the models as a priori, with socioeconomic variables handled as the main independent variables (social deprivation, smoking-status and comorbidities) of interest, followed by clinical variables. <h3>Results</h3> A total of 682 patients with pactiveRA and 1,026 contRA patients were included. Compared to contRA, patients with pactiveRA were younger (aged 58, interquartile range (IQR): 49, 67) vs (62, IQR: 52,72), included more females (69% vs 59%), were current or ex-smokers, and more likely to have depression, lung and gastrointestinal disease. Also, patients with pactiveRA had worse scores in patient reported outcomes at baseline and Patient Health Questionnaire Anxiety and Depression Screener. Logistic regression results are summarised in the Table 1. Age, gender, living in a socially deprived area and being an ex or current smoker, were independently associated with pactiveRA in models controlling for markers of disease severity (seropositivity). Baseline corticosteroid use was also associated with pactiveRA (p&lt;0.05 for all) and having a concomitant diagnosis of depression, odds ratio (OR) 2.30 (95%CI: 1.67,3.17), lung disease OR 1.46 (95%CI: 1.14,1.86) and gastric ulcer OR 1.71 (95%CI: 1.17,2.50) were significantly related to pactiveRA. <h3>Conclusion</h3> Sociodemographic factors (age, gender) and living in socially deprived areas were all associated with pactiveRA, independent of clinical and disease characteristics. Identifying 'adverse' socioeconomic factors that could drive persistent active disease early in the disease process, can help tailor interventions according to individual characteristics and need. <h3>References</h3> [1]de Hair MJ, Jacobs JW, Schoneveld JL, van Laar JM. Difficult-to-treat rheumatoid arthritis: an area of unmet clinical need. Rheumatology. 2018 Jul 1;57(7):1135-44. <h3>Acknowledgments</h3> FOREUM ECR 2020. <h3>Disclosure of Interests</h3> Maryam Adas: None declared, Sam Norton: None declared, Andrew Cope: None declared, Maya H Buch: None declared, James Galloway Speakers bureau: Abbvie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Novartis, Roche, Sanofi, Sobi and UCB, Consultant of: Abbvie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Novartis, Roche, Sanofi, Sobi and UCB, Elena Nikiphorou Speakers bureau: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Consultant of: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Grant/research support from: Pfizer and Lilly.